Adrenaline for cardiac arrest

Evidence Summaries

Level of Evidence = B
Adrenaline appears to increase survival to hospital discharge compared to placebo in out-of-hospital cardiac arrest. Improvement in neurological outcomes was not statistically significant.The quality of evidence is downgraded by study limitations (incomplete outcome data).

A Cochrane review 1 included 21 studies with a total of 21,704 subjects. The review provided moderate-quality evidence that standard-dose adrenaline compared to placebo improves return of spontaneous circulation, survival to hospital admission and survival to hospital discharge, but low-quality evidence that it did not affect survival with a favourable neurological outcome (table T1). Many of the studies were conducted more than 20 years ago.

Table 1. Standard-dose adrenaline (SDA) compared to placebo for out-of-hospital cardiac arrest.
Outcome Anticipated absolute effects* (95% CI) Relative effect (95% CI) Participants (studies) Certainty of evidence (GRADE)
Risk with placebo Risk with SDA
Survival to hospital discharge 23 per 1000 32 per 1000 (25 to 42) RR 1.44 (1.11 to 1.86) 8538 (2) Moderate (B)
Survival to hospital admission 83 per 1000 209 per 1000 (139 to 313) RR 2.51 (1.67 to 3.76) 8489 (2) Moderate (B)
Favourable neurological outcomes 19 per 1000 22 per 1000 (17 to 30) RR 1.21 (0.90 to 1.62) 8535 (2) Low (C)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio

References

1. Finn J, Jacobs I, Williams TA et al. Adrenaline and vasopressin for cardiac arrest. Cochrane Database Syst Rev 2019;(1):CD003179.  [PMID:30653257]


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